Hepatic Arterial Buffer Response in Liver Radioembolization and Potential Use for Improved Cancer Therapy

Liver radioembolization is a treatment option for unresectable liver cancers, performed by infusion of 90Y or 166Ho loaded spheres in the hepatic artery. As tumoral cells are mainly perfused via artery unlike lobules, twofold tumor to normal dose ratio commonly obtained. To improve cell killing while preserving co-infusion arterial vasoconstrictor has been proposed but with limited success: buffer response (HABR) and vascular escape mechanism hamper arterioles vasoconstriction. The project aims take benefit from HABR co-infusing mesenteric vasodilator: portal flow enhancement inducing vasoconstriction intra sinusoids barely impacts tumors that fed novel anarchic external arterioles. Animal studies were reviewed dopexamine was identified as promising safe candidate, reducing four lobules flow. A clinical trial design proposed. sixfold improvement tissue expected, pushing therapy towards real curative intention, especially HCC where ultra-selective delivery often not possible.